About the presenter: Dr. Ellen Bennett Lanouette has worked in the field for over 30 years in public school, university, and private practice settings. She received her bachelor's degree from the University of Texas at Austin, master's degree from California State University- Northridge, and Ph.D. from the University of Colorado at Boulder with an emphasis in stuttering disorders. She has co-authored numerous articles and presented many workshops at the local, state, national, and international level. In 2006, she published a comprehensive textbook focusing on the diagnosis and treatment of stuttering entitled Working with People Who Stutter: A Lifespan Approach. In 2007, she was the recipient of the NSA's Speech Language Pathologist of the Year award. Dr. Bennett Lanouette is the International Cluttering Association membership chair and currently works in the Hillsborough County Public Schools south of Tampa, Florida.

Cluttering is a disorder characterized by deficits in cognitive, linguistic, motor, speech, and pragmatic domains of communication. Over the years, various treatment paradigms have been published which focus on one or more of these domains (i.e., Bennett, 2006; Daly, 1992, 1996; Meyers, 2007; Myers & St. Louis, 1992; St. Louis, 2007; St. Louis & Myers, 1995,1997; St. Louis, Myers, Bakker, & Raphael, 2007; St. Louis, Raphael, Myers, & Bakker, 2003; Van Riper, 1971; Ward, 2006). A review of this corpus of information produced a list of overriding principles clinicians can use to assist the client through the therapy process. The following "tips for clinicians" is not all inclusive but just a starting point for therapy. Any therapy should be client-centered and fun. The following suggestions are put forth to assist clinicians when planning interactive, fun sessions with their clients who clutter.

1. Therapy should repeatedly review the rationales for treatment and the steps involved in the procedures so clients who clutter understand the "why" and "how" of treatment.

2. Clients must recognize that their speech is difficult for others to understand and that this is important for effective communication.

3. Drills that emphasize over-articulation of nonsense syllables facilitate proprioceptive feedback, thus enhancing the development of self-monitoring skills.

4. Teach coping mechanisms for clients to use when communicative efforts are not understood by the listener (i.e., relaxation, identification of non-verbal signals and facial expressions).

5. Teach the client to pace the amount of information provided at a time through the use of phrasing exercises. Phrasing, also called chunking, manipulates the length of utterance.

6. Help clients understand the role of silence in communication. People who clutter may not correctly interpret periods of silence or they may lack the use of silence during interactions.

7. Maintain a high degree of structure and routine within and between each session. Routine adds predictability to the therapy process which helps the client know what is expected.

8. Make therapy meaningful. Use work-related materials for the adult who clutters (i.e., professional journals, magazines of interest, crossword puzzles, etc.) when planning therapy. This principle facilitates transfer of skills into the client's everyday speaking environments.

9. Use role play to rehearse and analyze communication exchanges, particularly for the domains of topic maintenance, turn taking, and social appropriateness.

10. Limit off-task, extraneous comments during drill activities. Repetitive practice of material helps in the development of automatic use of skills. If the client practices briefly and inserts an off task comment, the clinician has to redirect back to the task which has been interrupted breaking the learning cycle.

References

Bennett, E.M. (2006a). Cluttering: Another fluency disorder. In Bennett, E.M., Working with people who stutter: A lifespan approach. Columbus, OH: Pearson Merrill Prentice Hall Publishers.

Daly, D.A. (1992). Helping the clutterer: Therapy considerations. In F.L. Myers and K.O. St. Louis (Eds.), Cluttering: A clinical perspective. Leicester: FAR Communications Reissued: San Diego, CA: Singular, 1996.

Daly, D.A. (1996). The source for stuttering and cluttering. East Moline, IL: LinguiSystems.

Myers, F.L. (2007). Primacy of self-awareness and the modulation of rate in the treatment of cluttering. Presentation at the First International Conference on Cluttering Disorders, Razslog, Bulgaria.

Myers, F.L. & St. Louis, K.O. (1992). Cluttering: A clinical perspective. Leicester: FAR Communications Reissued: San Diego, CA: Singular, 1996.

St. Louis, K.O. (2007). Thoughts about cluttering and the next ten years. Presentation at the First International Conference on Cluttering Disorders, Razslog, Bulgaria.

St. Louis, K.O. & Myers, F.L. (1995). Clinical management of cluttering. Language, Speech, and Hearing Services in the Schools, 26, 187-194.

St. Louis, K.O. & Myers, F. L. (1997). Management of cluttering and related fluency disorders. In Curlee, R. F. & Siegel, G. M. (Eds.). Nature and treatment of stuttering: New directions. Boston: Allyn and Bacon.

St. Louis, K. O., Myers, F. L., Bakker, K., & Raphael, L. J. (2007). Understanding and treating cluttering. In Conture, E.G. & Curlee, R.F. (Eds.) Stuttering and related disorders of fluency, 3rd ed. (pp. 297-325). NY: Thieme Medical Publishers.

St. Louis, K. O., Raphael, L. J., Myers, F. L., & Bakker, K. (2003, Nov. 18). Cluttering updated. The ASHA Leader, 4-5, 20-22.

Van Riper, C. (1971). The nature of stuttering. Englewood Cliffs, NJ: Prentice-Hall.

Ward, D. (2006). Stuttering and cluttering: Frameworks for understanding and treatment. NY: Psychology Press.

SUBMITTED: March 7, 2010

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